What is a fungal toenail and how do you get rid of it?
What are the treatment options and how effective are they?
It is estimated that 10% of Australians have an active fungal toenail infection, making it one of the more common condition we see in our foot clinics. Fungal toenail infection constitutes approximately 50% of all toenail conditions. An active infection can be moderately contagious but thankfully risk of transmission to loved ones can be reduced when the condition is managed correctly. With proper assessment, diagnosis and an individually tailored treatment plan even the most severe cases can be resolved.
At our foot clinics in Sydney patients can select from a comprehensive range of treatment options. When attending the clinic for the first time our honest and empathetic staff will discuss with you the various treatment modalities; their benefits, cost, success rates and potential side effects. If required in-house testing can also be performed to confirm diagnosis of fungal toenail infection on the spot. In some case your Podiatrist may also have to consult with your family GP to arrange prescription of oral antifungal medication.
Fungal toenail infections as notoriously difficult to resolve but after you see one of our Podiatrists you can rest easy knowing each treatment plan is geared specifically to your needs to achieve the best outcome.
what is a fungal toenail?
A fungal toenail infection or onychomycosis is where a fungal organism enters and infects the toenail complex. It can be caused by different types of fungal organisms but the most common is Trichophyton rubrum present in over 90% of all cases. Other dermatophytes can cause fungal toenail infections Trichophyton interdigitale, Trichophyton mentagrophytes or Tichophyton tonsuran). Yeasts (candida species) and nondermatophyte moulds can also cause fungal toenail infections.
These are the four main types of a fungal toenail infection:
Distal lateral subungual onychomycosis (DLSO)
This is a fungal toenail infection always caused by dermatophyte infection. It infects the lateral edges initially and then spreads down to the nail bed. There is usually tinea pedis/athlete’s foot found in the skin around the toenail.
Superficial white onychomycosis (SWO)
This type of fungal toenail infection is commonly caused by Trichophyton mentagrophytes affecting the surface of the nail plate rather than the nail bed; and is white in discoloration and nail plate is noticeably flaky.
Proximal white sub-ungual onychomycosis (PWSO)
This is an uncommon fungal toenail infection caused by rare strain of dermatophyte (Trichophyton tonsurans, Trichophyton mentagrophytes, Epidermophyton floccosum) often related to intercurrent disease among immunosuppressed patients. This is commonly seen in people with vascular disease and diabetes
Total dystrophic onychomycosis (TDO)
This is where the infection progresses, and the entire nail plate is completely contaminated and damaged.
Signs of a fungal toenail infection
Fungal toenail infections can be mistaken for other nail conditions as there are similarities in the physical presentation. Here are a few of the signs and symptoms of fungal toenail infection:
risk factors for fungal toenail infections
There are a few accepted factors which can increase your chance of developing a fungal toenail infection:
cross infection at home
Peripheral vascular disease
frequent immersion in water
testing for fungal toenails
It’s important to make sure that you have the correct diagnosis when it comes to fungal toenails. Properly identification is not only essential in treatment but also for prevention. Testing can occur in the form of microscopy and culture. Your GP can send you for both these tests after taking toenail clippings however it’s important to know that:
At the Foot Hub we offer a quick five-minute test which can gives accurate and clear result (98% success rate) for fungal toenails. Toenail clippings are taken during your appointment and tested looking for the presence or absence of dermatophytes in under 5 minutes by having a simple colour change. This allows us to accurately diagnosis fungal toenail infections where there is doubt and proceed with treatment.
Quality of life
Fungal toenail infection, like other foot conditions, is treatable and manageable. We understand that a fungal toenail infection and can affect your day to day life causing feelings of embarrassment and anxiety.
The embarrassment and anxiety caused by having the fungal toenail infection can adversely affect your social, emotional, and psychological well-being. As a result, some of our patients avoid activities such as swimming, going to the beach or wearing open shoes. A fungal toenail is not a life-threatening condition and there are numerous treatments available and we are here to help by providing treatment solutions to help your feel better about your feet and toenails.
Despite the high prevalence of fungal toenail infections and accounting for 50% of nail disorders, not all toenail discolouration is a fungal toenail. Podiatrists can assess and help diagnosis your toenail condition accurately. There are other toenail conditions that can look like a fungal toenail infection, these include:
Your Podiatrist will assess your toenail, medical history and take into account treatments which you may have tried in the past and provide an individualised fungal toenail treatment plan for you.
fungal toenail treatment
There are numerous ways to treat a fungal toenails infection. Effectiveness of treatment depends on how severe the infection is, type, symptoms, and any underlying medical conditions. At The Foot Hub we run through all treatment options to our patients and recommend treatment based on patient expectations, preferences, in line with evidence based medicine. The first stage to treatment is always patient education. We believe that understanding what a fungal toenail infection and its causes can help you understand this condition better and thus lead to better clinical outcomes.
Before treatment commences, we recommend anyone with a fungal toenail have a general podiatry treatment where the affected toenails are trimmed, and nail plate is filed down by a podiatry drill.
Toenails need to be 2mm thick for most antifungal toenail therapy to work, this also means home treatments like lacquers. There needs to adequate penetration into the nail plate and if your toenail is thick there is a low chance treatment (topicals, laser or medication) will work effectively.
Topical antifungals tend to be the initial treatment for most people with fungal toenail infections. This is usually an over the counter nail lacquer that is either purchased or compounded in a pharmacy. Treatment works by filing down the toenail and applying a liquid to the nail plate either daily or weekly depending on package instructions. There are many brands available and results vary amongst many people. To ensure a higher success rate we recommend:
Due to the limited efficacy of topical antifungals, oral medication can be recommended for treatment. The mostly commonly used drug is Terbinafine (oral Lamisil) which has a cure rate of 70%-80%, making it the most effective fungal toenail treatment. Other medications include Itraconazole or fluconazole.
Treatment duration depends on severity of infection and can take up to 12-24 weeks. Oral Lamisil is approved for safe use in Australia through prescription and is available on the Pharmaceutical Benefit Scheme. Like all medications, Terbinafine can cause side effects, but not everyone gets it them and will go way when you stop taking it. There are common side effects which 1 in 100 can experience and severe side effects being rare. We recommend talking to your GP for more information and eligibility for medication.
Photodynamic Therapy (PACT®)
In some cases, you may not want to or be able take or oral medication and have unsuccessfully tried topical antifungal treatment, PACT therapy can be a good treatment option. PACT therapy is a LED treatment that uses a photosensitising gel that causes fungal cell destruction. It is different to laser therapy which works by inhibiting growth of fungal cells. At our foot clinics we offer PACT therapy as an effective treatment option for our patients.
Total nail avulsion
In cases of total dystrophic onychomycosis where the entire toenail plate has been affected, chemical nail avulsion maybe warranted. In the past doctors would recommend surgical removing the toenail and commencing treatment. This is unnecessary as simply using a 40% cream on a toenail for a few weeks can bring about a painless way of removing a thickened and damaged toenail before starting antifungal treatment.
There are some natural remedies containing anti-fungal and anti-bacterial properties which you can use at home:
Prevention is the number one solution to combat fungal toenail infections. Here are some of the ways for you to prevent and the stop a fungal toenail from occurring:
complications of fungal toenails
Fungal toenail infection is treatable and manageable and strict observance of care plan should successfully treat the infection. There are instances; however, where fungal toenail treatment becomes difficult and persistent due to the following reasons:
frequently asked questions
There is no quick treatment to fungal toenail infection. Treatment would depend on the severity of the condition and your treatment preferences.
Fungal toenails are moderately contagious. They can be transmitted from one human to another especially among household with family members infected with fungus on toenail.
Anybody can get infected with fungal toenail infection. However there are some people who are more susceptible than others.
You may have more risk factors for developing fungal infections. It’s important to know that once you have had a fungal toenail infection, there is a chance of reoccurrence.
No, you should not ignore your fungal toenail infection as it can worsen if left untreated leading to more serious condition such as permanent nail damage, infection in other toenails and tinea pedis
Consult with your podiatrist if you suspect you have fungal toenail infection for earlier treatment plan.
Unfortunately, fungal toenail infection, like other infections, does not go away on its own. Consult with your podiatrist for any type of foot concerns for treatment options and correct professional diagnosis of your foot condition.
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Not all nail conditions are fungal toenails. It’s important to make sure that you have the correct diagnosis when treating your toenails as it can help improve treatment outcomes. Learn about other conditions that can effect your toenails.